"Obamacare" finds itself between a rock and hard place, as another major state has opted to not put together its own health exchange, leaving the burden to the federal government that some say isn't ready to launch its own system.
The latest to step aside is Gov. Chris Christie in New Jersey, who got awfully close to Pres. Barack Obama during the closing days of the 2012 presidential campaign but seems content to keep his distance now.
Under the Affordable Care Act, states have the option of either setting up their own exchanges for selling and buying health insurance, or relying on the federal government to do it. On Thursday, Christie vetoed a bill that would have put New Jersey in the former camp.
"I will not ask New Jerseyans to commit today to a state-based exchange when the federal government cannot tell us what it will cost, how that cost compares to other options and how much control they will give the states over this option that comes at the cost of our state's taxpayers," Christie said in a statement, according to Reuters.
The deadline to decide is Dec. 14. So far, 18 states have opted to create their own exchanges, and 18 have declined.
The Obama administration has been scrambling to get its system in place ahead of the 2013 scheduled launch. Last week, the Department of Health and Human Services announced that it would charge insurers a fee for operating the exchange system.
"In proposing the new rule, Kathleen Sebelius, the secretary of Health and Human Services, said that fees charged by the federal government would be 'sufficient to cover the majority of costs related to the operation of federally facilitated exchanges.' She did not say how the remainder of the money would be raised," the New York Times reported.
"The federal government has the authority under Obamacare to create health insurance exchanges in states that don't enact their own," noted Jeffrey Young in the Huffington Post, "but the law was designed for federal authorities and states to share the responsibility. Lack of cooperation from states and poor coordination between levels of government could make the exchanges less effective at enrolling uninsured people into health coverage programs."
The political calculus in deferring to the Feds on the exchange, wrote the editors of the Wall Street Journal, is that there are so many uncertainties and undetermined costs. If governors set up their own system, they will bear the brunt of criticism when things go wrong.
"So if things don't work voters will blame the governors for decisions made in Washington. And when it turns out that Obamacare's costs are underestimated and its benefits exaggerated, they'll have enabled an entitlement that many of their constituents oppose. The wonder is that any GOP leaders — ahem, Chris Christie and Rick Scott — are still playing Hamlet," the Journal editors argued.
Eric Schulzke writes on national politics for the Deseret News. He can be contacted at [email protected].